Smouha Eric E, Yoo Michael, Mohr Kristi, Davis Raphael P
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine, State University of New York at Stony Brook, Stony Brook, New York, USA.
Laryngoscope. 2005 Mar;115(3):450-4. doi: 10.1097/00005537-200503000-00011.
OBJECTIVES/HYPOTHESES: Conservative management is a viable treatment alternative for acoustic neuroma. Using previous studies to provide evidence-based support, we have attempted to more clearly define the role of conservative management.
Retrospective review of literature and patient charts.
Published studies on conservative management of acoustic neuroma were found using a key word search through PubMed in addition to the bibliographies of these selected studies. A spreadsheet was made to tabulate the selection criteria for conservative management, duration and frequency of follow-up, patient demographics, initial tumor size and rate of growth, change in hearing status, and the need for definitive treatment.
A total of 21 studies comprising 1,345 patients were included in our meta-analysis. The average length of follow-up these studies was 3.2 years. The average initial tumor size was 11.8 mm (n = 900); 43% of 1,244 acoustic neuromas showed growth, whereas 57% showed either no growth or tumor regression. The average growth rate was 1.9 mm/year in 793 individuals. Hearing loss occurred in 51% of 347 individuals. In 15 studies, 20.0% of 1,001 individuals eventually failed conservative management.
Our meta-analysis supports the role of conservative management of acoustic neuromas in properly selected patients on the basis of a slow overall rate of growth and a substantial incidence of no growth. However, the lack of predictive factors, the relatively short duration of follow-up, and the variability of inclusion criteria underscore the need for continued collection of long-term data. An algorithm for acoustic neuroma management is proposed based on initial tumor size, patient age, and hearing status.
目的/假设：保守治疗是听神经瘤一种可行的治疗选择。我们利用先前的研究提供循证支持，试图更明确地界定保守治疗的作用。
对文献和患者病历进行回顾性研究。
除了通过所选研究的参考文献外，还通过PubMed关键词搜索，查找已发表的关于听神经瘤保守治疗的研究。制作了一个电子表格，将保守治疗的选择标准、随访时间和频率、患者人口统计学数据、初始肿瘤大小和生长速度、听力状况变化以及确定性治疗需求制成表格。
我们的荟萃分析共纳入了21项研究，涉及1345名患者。这些研究的平均随访时间为3.2年。平均初始肿瘤大小为11.8毫米（n = 900）；1244例听神经瘤中，43%出现生长，而57%无生长或肿瘤缩小。793例患者的平均生长速度为1.9毫米/年。347例患者中有51%出现听力损失。在15项研究中，1001例患者中有20.0%最终保守治疗失败。
我们的荟萃分析支持在根据总体生长速度缓慢和无生长发生率较高适当选择的患者中对听神经瘤进行保守治疗。然而，缺乏预测因素、随访时间相对较短以及纳入标准的变异性突出表明需要持续收集长期数据。基于初始肿瘤大小、患者年龄和听力状况，提出了一种听神经瘤治疗算法。
